CAJ | 학술논문

背景：髓核摘除后椎间盘会随时间出现什么样的影像学及组织病理学变化，目前尚不明确。 　　目的：观察兔腰椎间盘髓核穿刺抽吸术后影像学及组织病理学的变化。 　　方法：32只日本大耳白兔，用21号针头行L3/4椎间盘后外侧穿刺抽吸出部分髓核组织，L2/3椎间盘作为正常对照椎间盘，于抽吸后2，4，8，12周时按照分组取8只兔子行腰椎侧位X射线检查，测量L3/4、L2/3高度并计算椎间盘高度指数，行正中矢状位MRI检查及椎间盘组织病理学检查。 　　结果与结论：髓核抽吸后2，4，8，12周椎间盘高度呈逐渐降低趋势，但8-12周变化减小，与正常对照组椎间盘相比，各时间点椎间盘高度指数显著降低(P<0.05)。抽吸后2，4，8，12周的髓核信号强度随时间逐渐降低，8周时已达改良Thompson分级标准的4级。抽吸后凝胶状髓核组织随时间逐渐出现裂隙，形态逐渐紊乱，12周时呈现明显的纤维化表现，髓核4周时出现较多的类软骨细胞，呈现活跃状态，髓核细胞明显减少，抽吸后8，12周髓核内纤维样细胞增多，类软骨细胞数量减少，纤维环随时间逐渐出现扭曲，排列紊乱，突起，出现分层、纤维断裂现象。说明后外侧纤维环穿刺髓核抽吸后，兔腰椎间盘X射线高度、MRIT2加权信号强度随时间逐渐降低、减弱，椎间盘组织逐渐出现退变病理改变，但8-12周其变化趋于缓和。
배경：수핵적제후추간반회수시간출현십요양적영상학급조직병이학변화，목전상불명학。 　　목적：관찰토요추간반수핵천자추흡술후영상학급조직병이학적변화。 　　방법：32지일본대이백토，용21호침두행L3/4추간반후외측천자추흡출부분수핵조직，L2/3추간반작위정상대조추간반，우추흡후2，4，8，12주시안조분조취8지토자행요추측위X사선검사，측량L3/4、L2/3고도병계산추간반고도지수，행정중시상위MRI검사급추간반조직병이학검사。 　　결과여결론：수핵추흡후2，4，8，12주추간반고도정축점강저추세，단8-12주변화감소，여정상대조조추간반상비，각시간점추간반고도지수현저강저(P<0.05)。추흡후2，4，8，12주적수핵신호강도수시간축점강저，8주시이체개량Thompson분급표준적4급。추흡후응효상수핵조직수시간축점출현렬극，형태축점문란，12주시정현명현적섬유화표현，수핵4주시출현교다적류연골세포，정현활약상태，수핵세포명현감소，추흡후8，12주수핵내섬유양세포증다，류연골세포수량감소，섬유배수시간축점출현뉴곡，배렬문란，돌기，출현분층、섬유단렬현상。설명후외측섬유배천자수핵추흡후，토요추간반X사선고도、MRIT2가권신호강도수시간축점강저、감약，추간반조직축점출현퇴변병리개변，단8-12주기변화추우완화。
BACKGROUND:It remains unclear what kind of changes in imaging and histopathology would appear in intervertebral disc after removal of nucleus pulposus over time. OBJECTIVE:To observe the alteration in imaging and histopathology of rabbit lumbar intervertebral disc after nucleus pulposus aspiration. METHODS:A total of 32 Japanese rabbits were subjected to nucleus pulposus aspiration in posterior lateral L 3/4 intervertebral disc with a 21-gauge hypodermic needle. L 2/3 intervertebral disc served as a normal control. At 2, 4, 8 and 12 weeks after aspiration, eight rabbits according to grouping received radiograph in the lateral position of lumbar vertebra. The height of L 3/4 and L 2/3 intervertebral space was measured and intervertebral disc height index was calculated. Rabbits received median sagittal MRI examination and histopathological examination of intervertebral disc. RESULTS AND CONCLUSION:The intervertebral disc height degraded slowly at 2, 4, 8, and 12 weeks after aspiration. However, the difference between 8 and 12 weeks was reduced. Compared with normal control, intervertebral disc height index significantly reduced at various time points (P<0.05). The nucleus pulposus signal intensity was gradual y reduced at 2, 4, 8, and 12 weeks after aspiration, and reached grade 4 of modified Thompson grading criteria at 8 weeks. After aspiration, gelatinous nucleus pulposus of disc slowly exhibited fissures with time, morphous was slowly disordered and showed significant fibrosis performance at 12 weeks. In nucleus pulposus region, more cartilage-like cells were found at 4 weeks after operation. The cells were active. Nucleus pulposus cells decreased significantly. At 8 and 12 weeks after operation, fibroblasts increased in nucleus pulposus region, and the number of cartilage-like cells reduced. The annulus fibrosus gradual y became distorted, disordered, with processes and layers, and fiber breakage appeared. These results indicated that after puncturing lateral annulus fibrosus and aspirating the nucleus pulposus, radiograph height of the intervertebral disc and MRI T2-weighted signal intensity gradual y reduced. Pathological changes were observed. However, the degeneration al eviated between 8-12 weeks.